WASHINGTON--(BUSINESS WIRE)--Today, Council for Citizens Against Government Waste (CCAGW) President
Tom Schatz sent a letter
to the U.S. House of Representatives strongly urging members to neither
co-sponsor nor vote for Rep. Sam Graves’ (R-Mo.) legislation H.R.
1250, the Medicare Audit Improvement Act of 2013, which would
gravely undermine the most effective oversight tool at taxpayers’
disposal to combat rampant improper billing in the Medicare
fee-for-service program, the Recovery Audit Contractor (RAC) program.
RACs have recovered $7.6 billion in improper overpayments since fiscal
year (FY) 2010 and extended the life of the troubled Medicare Trust
Fund. The CCAGW letter reads in part:

“H.R. 1250 is a direct assault on Medicare’s Recovery Audit Contractor
(RAC) program, which is one of the most successful oversight tools
taxpayers have ever had. Between fiscal year (FY) 2009, when the
nationwide rollout of the RAC program began, and FY 2012, improper
payment rates in Medicare fell from 10.8 percent to 8.5 percent.
However, in its FY 2013 Financial Report, the Department of Health and
Human Services documented that Medicare improper payment rates are once
again above 10 percent.

“If enacted, H.R. 1250, would substantially damage the RAC program.
Despite the bill’s purported intent to relieve the cost of compliance
for some of the nation’s hospitals, this legislation will instead allow
CMS to turn a blind eye toward chronic, widespread shoddy billing
practices by Medicare providers and relax, rather than strengthen,
oversight of Medicare billing practices.

“The bill includes a provision that would only allow audits when there
is an estimated billing error rate of more than 40 percent. It is
difficult to believe that members of Congress would support legislation
that allows Medicare providers to bill improperly, so long as they do
not hit an error rate over 40 percent. This astonishing stipulation is
tantamount to sanctioning a 60 percent ‘success’ rate, the equivalent of
a failing grade in school. The error rate provision alone would cause
Medicare to hemorrhage tens of billions of dollars in improper payments.
Taxpayers can and should expect a higher standard of performance from
hospitals and other Medicare providers. Indeed, there should be no
minimum error rate before Medicare auditors are allowed to investigate
potential waste, fraud, and abuse.

“The bill’s sponsors have argued that the program is burdensome on
hospitals and have included a cap on the number of medical records a RAC
may request from a healthcare provider. However, RACs are the only
post-payment program integrity contractors that already are subject to
such a cap, which is a mere 2 percent of a hospital’s Medicare claims
volume.

“The consolidation provision would impose the 2 percent cap collectively
across all audit program integrity efforts, virtually eviscerating the
RACs’ ability to review medical records for improper payments, the key
to identifying waste, fraud, and abuse in the most cost-effective manner.

“Furthermore, H.R. 1250 mandates additional, unnecessary reporting
requirements and penalties on RACs, even though they are already
required to be the most transparent and accountable of CMS’ post-payment
auditors. The bill would penalize the RACs for overturned
determinations. Yet RACs are compensated on a contingency basis, operate
at no cost to the taxpayers, and receive no compensation for any
decisions that are overturned on appeal. According to CMS, RACs have an
accuracy rating of more than 90 percent, and only 3 percent of their
improper payment determinations were overturned on appeal in FYs 2010
and 2011.

“Since 2001, Congress has overwhelmingly approved three separate bills
to help eliminate improper payments government-wide. H.R. 1250
undermines the intended effects of these laws. I urge you to oppose any
efforts to roll back the highly effective RAC oversight program, which
has already collected $7.6 billion in overpayments since FY 2010 and
helped to extend the life of the Medicare Trust Fund.”

CCAGW representatives are available for interviews regarding the RAC
issue.To book an interview with CCAGW President Tom Schatz or
CCAGW V.P. for Policy & Communications Leslie K. Paige, please contact
Alexandra Booze at (202) 467-5300 or abooze@cagw.org.